It is important to differentiate between tests that look for antibodies and tests that look for antigens, or the actual organisms (or DNA of the organisms themselves). Antibody testing can be highly unreliable (as can antigen testing). Lyme disease often evades the immune system and thus false-negatives are not uncommon. It may be only after the start of treatment that one finds a Western Blot, for example, becoming positive. This is generally due to the recovery of the immune system and the immune system's ability to now begin to mount an attack and recognize the foreign invaders.
1) ELISA (Enzyme Linked Immunoassay) - a simple, inexpensive test for detection of antibodies created as a response to an infection with Borrelia Burgdorferi (the main causative agent in Lyme disease). Personally, I do not believe this test is of any significant value and may represent a doctor that is not well-versed in diagnosing and treating Lyme disease. It may be a sign to turn and run to find a new doctor if your doctor is relying on an ELISA test to determine the course of your care. In one study, the test was found to be 55% inaccurate. Thus the odds are better with a simple coin toss. The test is not recommended until at least four weeks after exposure. The C6-peptide ELISA is a more accurate form of the ELISA test though still not recommended. A positive ELISA must be followed up with a Western Blot.
2) Western Blot - This is likely the most commonly used test for Lyme disease. It is still an antibody test and thus false negatives are not uncommon, but it is, in my opinion, an important place to start. Western Blot test results will include both IgG and IgM assays. In many traditional infections, IgM is an indication of recent infection whereas IgG is an indicator of late infection. With Lyme Disease, there appears to be a cycling between IgM and IgG and thus, these are not accurate indicators of the length of time the infection has been present in most cases. In my opinion, IGeneX is the best place to have this test performed.
It is critically important that one not look at the NEGATIVE or POSITIVE summary result of the Western Blot test. That criterion is based on CDC guidelines which many argue are not appropriate for Lyme disease. Instead, it is important to look at all of the bands and map those to the known Lyme-specific bands (those bands that represent evidence of serological exposure to Borrelia Burgdorferi). According to Dr. Charles Ray Jones, these are: 18 23 30 31 34 37 39 83 93. Other doctors focus on 23-25, 31, 34, 39, 83-93 as the most specific bands. Additional information on the specific bands and what they mean can be found here.
If any of these bands appear in either IgG or IgM, that is a likely indication of past or present infection with the causative agent in Lyme disease. Thus, that is NOT a clear "negative" test result; "something" consistent with infection with Borrelia was observed. Some labs reports only + (positive) and - (negative) and ignore equivocal or IND (indeterminate) bands. This is, in my opinion, an error. If anything is visible, this is not negative. Quest, for example, does not report IND bands whereas IGeneX does. In my opinion, testing for Lyme disease via Quest, and most other major labs, is not ideal as they do not test for bands 31 and 34 which where used for Lyme vaccine development. Something else to consider is that most labs in the US only test for Borrelia burgdorferi. This may miss many strains of the Borrelia organisms, especially those from Europe.
IGeneX also offers a 30-31kDa Confirmation IgG and IgM test. If results from the initial Western Blot are positive for bands 30 or 31 only, it is possible that these could be due to cross-reactivity with several different types of viruses. In this confirmatory test, highly specific recombinant antigens are used to validate that the positive result is not due to cross-reaction with viruses.
3) PCR (polymerase chain reaction) - a sensitive method of testing where minute amounts of DNA are looked for. In a presentation that I attended by Dr. Aristo Vojdani PhD, it was noted that PCR tests are positive somewhere between 6% and 15% of the time. Thus, it was stated that this is not generally a useful test for the evaluation of Lyme Disease. For PCR to be useful, it should be expected that it may take repeated tests in order to get a positive result.
4) Lyme DOT-BLOT is an assay for the direct detection of Lyme antigen in the urine. The Reverse Western Blot is an antigen detection test in urine where the urine is exposed to rabbit antibodies for Borrelia burgdorferi.
5) IGeneX offers the IFA (immunofluorescence assay) for Borrelia. It has shown many people that have had consistently equivocal or negative results that, in fact, they do have results consistent with Lyme disease. IGeneX also offers a Babesia FISH and a Bartonella FISH (Fluorescent In Situ Hybridization). These are antigen detection tests and not antibody tests.
6) CD57 - We have all likely heard of people with HIV/AIDS getting their T-cell counts or CD-4 cell counts checked on a regular basis. Current information suggests that there is a similar population of NK (natural killer) cells called CD57 cells that are known only to be suppressed in the presence of Lyme disease. Generally guidelines are that a score of < 20 indicates advanced or highly active Lyme disease. Scores of 20-60 are indicative of active Lyme disease where scores > 60 start to suggest that the Lyme infection is less active. A normal test result would be > 200. It is the opinion of some doctors that treatment is necessary until the CD57 test score is 150 or above. The lower the result, the more likely a relapse if treatment is terminated.
The test can be an indication of progression of disease or of progress in treatment. However, it should be noted that it is not uncommon to see only small changes in the results until the end of treatment where the results often then jump quickly to higher levels. It may be the case that this test can both be used as an indicator of Lyme disease presence and as a marker for when to consider stopping treatment. Unfortunately, there are people that feel they are recovering and still have low CD57 scores as well as those that have high scores and are still quite ill. The test doesn't seem to provide consistent value for every patient. For more information on the CD57, go here. The test is now available through both LabCorp and, as of late 2010, IGeneX.
8) Another lab for Tick-Borne Infections is Clongen. I've heard the director of this lab speak at conferences and they appear to have a number of useful tests. I did perform a couple of their tests and was surprised that they did not find anything in my samples. That said, I had already been treated for quite some time for Lyme so I wasn't the best test subject.
Update: While I have had some feedback that the results from some that used this lab for testing were negative when positive results were anticipated, it is another option for those looking for Lyme-related testing.
12) Spiro Stat Technologies emerged in early 2010. Dr. Lee Cowden said in a presentation in April 2010 that Spiro Stat is the only lab that he would use for Lyme disease at that time. Their panel included a lengthy list of microorganisms. I was impressed that they even include the common dental pathogen, Treponema denticola. They offered a Lyme Panel, a Babesiosis Panel, and a Fungi Panel. I talked in more detail about this option in a blog that can be found here.
13) The newest lab to start testing for Borrelia as of late 2011 is Advanced Laboratory Services. This is the first commercially available culture test for Borrelia. This lab has the potential to be a game changer in the world of Lyme disease. If the actual organism can be cultured after years of treatment, the argument over persistence of the organism may be forced to change.
They offer testing for Lyme and all common coinfections. Dr. Schwarzbach is highly respected in the ILADS community and ArminLabs provides another option for vector-borne infection testing. More information is available here.
such as rolfing or similar in order to increase the sensitivity of the testing by moving microbes out of tissues. The test is a urine test. I first learned about this test from Dr. Dietrich Klinghardt, and I do think it is a good option. Details on their testing can be found here.
My experience has been that testing for co-infections is a critically important piece of the puzzle. My initial Western Blot was equivocal and yet, I had evidence of Babesia, Ehrlichia and Bartonella. This helped to round out the facts in support of my Lyme Disease diagnosis. I have had the clearest results from the standard IgM/IgG antibody tests (outside of energetic medicine using ART or EAV which were far superior in my experience) from IGeneX and the test above from Fry Clinical Labs when it comes to co-infections. I also firmly believe that people with Lyme generally have at least one co-infection (in fact I would go as far as to say almost always if not always). Each co-infection may require different types of treatments and unless all of them are addressed, the chances of recovery are lessened. Here are some additional thoughts on co-infections:
- Co-infections are the RULE, not an exception
- The average child with Lyme has 2-5 co-infections with an average of 3.
- Treatment of co-infections is required and often, they must be treated BEFORE or concurrent with the Borrelia treatment itself.
- If you don't test for and treat co-infections, you are not putting yourself in a good position for healing.
- Almost everyone with chronic Lyme likely has 1 or more co-infections.
- Co-infections require DIFFERENT treatments in many cases. Do not assume that you are covering them with only the Lyme treatment. Many people don't even know which ones they have.
- Co-infection testing is often unreliable as well and you need to repeat them over time. It took 4 months for my Bartonella to appear and almost 8 for Babesia to finally appear, but they were there.
- If you think you only have Borrelia, odds are you have not looked closely enough.
My current preferred approach for testing for co-infections is to use IGeneX (particularly the Babesia and Bartonella FISH tests). For Bartonella, Galaxy Diagnostics appears to be a very good option as well.
- Lyme ImmunoBlot Panel 3 (IB3) from IGeneX which include the new ImmunoBlot, the Lyme IFA, and PCR.
- Lyme Panel from DNA Connexions (after significant body work)
- Lyme Panel from DNA Connexions (after significant body work)
- Coinfection Panel 3 (CP3) from IGeneX which includes Babesia antibody and FISH testing, Ehrlichia/Anaplasma antibody testing, and Bartonella antibody and FISH testing.
- Bartonella testing from Galaxy Diagnostics.
I would also definitely do a good heavy metal urine challenge test, viral testing, and a good parasite test. All too often, people focus too much on just the Lyme and in my opinion miss many of the other important things that are also going on.
In Better Health,